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1.
Ital J Pediatr ; 46(1): 143, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023602

RESUMO

The Veneto region is one of the most affected Italian regions by COVID-19. Chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), may constitute a risk factor in COVID-19. Moreover, respiratory viruses were generally associated with severe pulmonary impairment in cystic fibrosis (CF). We would have therefore expected numerous cases of severe COVID-19 among the CF population. Surprisingly, we found that CF patients were significantly protected against infection by SARS-CoV-2. We discussed this aspect formulating some reasonable theories.


Assuntos
Infecções por Coronavirus/epidemiologia , Fibrose Cística/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Técnicas de Laboratório Clínico/métodos , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Fibrose Cística/diagnóstico , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Valores de Referência , Estudos Retrospectivos , Medição de Risco
2.
Medicine (Baltimore) ; 99(35): e21891, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871919

RESUMO

To analyze the relationship between aortic measures and biometric parameters in a large cohort of consecutive patients undergoing computed tomography coronary angiography.1170 patients (717 men/453 women) performing computed tomography coronary angiography for coronary evaluation were retrospectively evaluated. Aortic diameters and areas were measured at reproducible anatomic landmarks, perpendicular to the axis of vessel, at the level of the aortic root (AoR), the sinotubular junction (STJ), and the tubular ascending aorta (TAo). Biometric parameters and cardiovascular risk factors were recorded.The average values of AoR, STJ, and TAo were 35.63 ±â€Š5.00 mm, 30.56 ±â€Š4.82 mm, 35.07 ±â€Š5.84 mm. Hypertension was significantly associated with aortic dimensions.Aortic measures were significantly different between men and women (37.56 ±â€Š4.77 mm vs 32.58 ±â€Š3.68 mm for AoR, 31.88 ±â€Š4.84 mm vs 28.47 ±â€Š3.98 mm for STJ and 35.93 ±â€Š5.86 mm vs 33.70 ±â€Š5.54 mm for TAo) (P < .001) and linearly increased with age. Low Spearman correlation coefficients were found and the correlation of TAo diameters with age displayed the highest values (ρ = 0.372 for male and ρ = 0.373 for female, P < .001). Multiple linear regression analysis models were compared by R. The best model used body surface area (BSA) and age as independent variables and TAo diameter as dependent variable (R = 0.29 for AoR; R = 0.21 for STJ, and R = 0.20 for TAo).In conclusion, in our population low correlation between aortic dimensions and biometric parameters highlights the difficulty of identifying normal ranges, as well as issues related to normalization using conventional biometric parameters.


Assuntos
Aorta/anatomia & histologia , Aorta/diagnóstico por imagem , Biometria , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/patologia , Angiografia Coronária , Tomografia Computadorizada por Raios X , Fatores Etários , Idoso , Superfície Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
3.
Cochrane Database Syst Rev ; 9: CD010315, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32905623

RESUMO

BACKGROUND: This is the second update of the review first published in 2017. Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure to below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. OBJECTIVES: To determine if lower blood pressure targets (135/85 mmHg or less) are associated with reduction in mortality and morbidity as compared with standard blood pressure targets (140 to 160/90 to 100 mmHg or less) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). SEARCH METHODS: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials (RCTs) up to November 2019: Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE (from 1946), Embase (from 1974), and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982), along with the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. We applied no language restrictions. SELECTION CRITERIA: We included RCTs with more than 50 participants per group that provided at least six months' follow-up. Trial reports had to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions involved lower targets for systolic/diastolic blood pressure (135/85 mmHg or less) compared with standard targets for blood pressure (140 to 160/90 to 100 mmHg or less). Participants were adults with documented hypertension and adults receiving treatment for hypertension with a cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease, or angina pectoris. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed search results and extracted data using standard methodological procedures expected by Cochrane. We used GRADE to assess the quality of the evidence. MAIN RESULTS: We included six RCTs that involved 9484 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). All RCTs provided individual participant data. None of the included studies was blinded to participants or clinicians because of the need to titrate antihypertensives to reach a specific blood pressure goal. However, an independent committee blinded to group allocation assessed clinical events in all trials. Hence, we assessed all trials at high risk of performance bias and low risk of detection bias. Other issues such as early termination of studies and subgroups of participants not predefined were also considered to downgrade the quality evidence. We found there is probably little to no difference in total mortality (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.91 to 1.23; 6 studies, 9484 participants; moderate-quality evidence) or cardiovascular mortality (RR 1.03, 95% CI 0.82 to 1.29; 6 studies, 9484 participants; moderate-quality evidence). Similarly, we found there may be little to no differences in serious adverse events (RR 1.01, 95% CI 0.94 to 1.08; 6 studies, 9484 participants; low-quality evidence) or total cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization, or death from congestive heart failure) (RR 0.89, 95% CI 0.80 to 1.00; 6 studies, 9484 participants; low-quality evidence). The evidence was very uncertain about withdrawals due to adverse effects. However, studies suggest more participants may withdraw due to adverse effects in the lower target group (RR 8.16, 95% CI 2.06 to 32.28; 2 studies, 690 participants; very low-quality evidence). Systolic and diastolic blood pressure readings were lower in the lower target group (systolic: mean difference (MD) -8.90 mmHg, 95% CI -13.24 to -4.56; 6 studies, 8546 participants; diastolic: MD -4.50 mmHg, 95% CI -6.35 to -2.65; 6 studies, 8546 participants). More drugs were needed in the lower target group (MD 0.56, 95% CI 0.16 to 0.96; 5 studies, 7910 participants), but blood pressure targets were achieved more frequently in the standard target group (RR 1.21, 95% CI 1.17 to 1.24; 6 studies, 8588 participants). AUTHORS' CONCLUSIONS: We found there is probably little to no difference in total mortality and cardiovascular mortality between people with hypertension and cardiovascular disease treated to a lower compared to a standard blood pressure target. There may also be little to no difference in serious adverse events or total cardiovascular events. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on withdrawals due to adverse effects, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (135/85 mmHg or less) in people with hypertension and established cardiovascular disease. Several trials are still ongoing, which may provide an important input to this topic in the near future.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/tratamento farmacológico , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/efeitos adversos , Viés , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/mortalidade , Diástole , Humanos , Hipertensão/complicações , Hipertensão/mortalidade , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Valores de Referência , Sístole
4.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32948657

RESUMO

OBJECTIVES: To determine the natural history of pediatric hypertension. METHODS: We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared. RESULTS: Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among these 43 825 children, 4.3% (1881) met criteria for hypertension (3.5% [1515] stage 1, 0.8% [366] stage 2) and 4.9% (2144) met criteria for elevated blood pressure in the first 36 months. During the second 36 months, 50% (933) of hypertensive patients had no abnormal blood pressure levels, 22% (406) had elevated blood pressure levels or <3 hypertensive blood pressure levels, and 29% (542) had ≥3 hypertensive blood pressure levels. Of 2144 patients with elevated blood pressure in the first 36 months, 70% (1492) had no abnormal blood pressure levels, 18% (378) had persistent elevated blood pressure levels, and 13% (274) developed hypertension in the second 36-months. Among the 7775 patients with abnormal blood pressure levels in the first 36-months, only 52% (4025) had ≥3 blood pressure levels recorded during the second 36-months. CONCLUSIONS: In a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.


Assuntos
Determinação da Pressão Arterial/estatística & dados numéricos , Hipertensão/diagnóstico , Adolescente , Fatores Etários , Estatura , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Valores de Referência , Análise de Regressão , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo
5.
Respir Res ; 21(1): 252, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993656

RESUMO

SARS-CoV-2 is causing a pandemic with currently > 29 million confirmed cases and > 900,000 deaths worldwide. The locations and mechanisms of virus entry into the human respiratory tract are incompletely characterized. We analyzed publicly available RNA microarray datasets for SARS-CoV-2 entry receptors and cofactors ACE2, TMPRSS2, BSG (CD147) and FURIN. We found that ACE2 and TMPRSS2 are upregulated in the airways of smokers. In asthmatics, ACE2 tended to be downregulated in nasal epithelium, and TMPRSS2 was upregulated in the bronchi. Furthermore, respiratory epithelia were negative for ACE-2 and TMPRSS2 protein expression while positive for BSG and furin, suggesting a possible alternative entry route for SARS-CoV-2.


Assuntos
Asma/virologia , Infecções por Coronavirus/genética , Regulação da Expressão Gênica , Pneumonia Viral/genética , Serina Endopeptidases/genética , Síndrome Respiratória Aguda Grave/virologia , Fumar/epidemiologia , Asma/fisiopatologia , Bases de Dados Factuais , Humanos , Pandemias , Receptores Virais/genética , Valores de Referência , Sistema Respiratório/metabolismo , Sistema Respiratório/virologia , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/metabolismo , Fumar/fisiopatologia , Internalização do Vírus
6.
Medicine (Baltimore) ; 99(38): e22214, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957357

RESUMO

Anti-thyroid peroxidase antibody (TPO-Ab), which is the known cause of autoimmune thyroid disease, enhances proinflammatory cytokine responses. Since low-grade inflammation is a known risk factor for atherosclerosis, a normal range of TPO-Ab (TPO-Ab negative) could be positively associated with atherosclerosis among participants with normal thyroid function. However, no study reported the association between normal range of TPO-Ab and atherosclerosis among eu-thyroid participants. A cross-sectional study was conducted with 1165 Japanese individuals with normal thyroid function (ie, normal range of free triiodothyronine [free T3] and free thyroxine [free T4]), aged 40 to 74 years, who participated in an annual health checkup in 2014. Among the study population, 115 were diagnosed as having atherosclerosis. A normal range value of TPO-Ab titer is revealed to be positively associated with atherosclerosis; sex, age, thyroid function (free T3 and thyroid-stimulating hormone), and known cardiovascular risk factor adjusted odds ratio and 95% confidence interval of atherosclerosis for logarithmic values of TPO-Ab was 2.23 (1.11, 4.47). When we limited the analysis to participants with normal levels of thyroid-stimulating hormone, this association became slightly stronger (2.65 [1.27,5.51]). Among the eu-thyroid general population, a normal range of TPO-Ab titer is revealed to be positively associated with atherosclerosis. Even though a TPO-Ab titer is not clinically relevant and is not associated with autoimmune thyroid disease, it could influence endothelial remodeling including atherosclerosis.


Assuntos
Aterosclerose/sangue , Autoanticorpos/sangue , Iodeto Peroxidase/imunologia , Idoso , Grupo com Ancestrais do Continente Asiático , Aterosclerose/imunologia , Autoanticorpos/imunologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Tireotropina/sangue
7.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
8.
Medicine (Baltimore) ; 99(39): e22392, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991461

RESUMO

Assessment of skeletal maturity is crucial for managing growth related problems. Tanner and Whitehouse (TW) hand and wrist bone age assessment is an accurate method; however, it is complex and labor-intensive. Several simplified methods derived from the TW method were proposed, and each had its own character. The purpose of this study is to explore the relationship between these methods for accurate usage.Between 2018 and 2019, a cross-sectional study was performed with consecutive left hand and wrist x-rays obtained from a pediatric orthopedic clinic. Bone age assessments included the distal radius and ulna (DRU) classification, Sanders staging (S), thumb ossification composite index (T), and TW method. Somers delta correlation was conducted to determine the interchangeability of these stages. The mean bone age and standard deviation (SD) of each subgrade were compared and analyzed.Totally 103 films (92 girls) were analyzed with mean age of 12.1 years (range: 8.0-17.9 years). The radius (R) stages had good correlation with S, T, and U stages with a very high Somers delta correlation (P < .05). R5 had relatively large SD (1.5) and referred to T2 and T3; R6 and R7 had the smallest SD (0.3) with reference to T4 or S2; R8 referred to T5 or S3, S4, S5; R9 referred to S6 and S7.The internal relationship between the DRU and digital stages system was well proven. We also provided a simple and accurate way to assess the bone age by combination of some subgrades with smaller SD: 10y-proximal thumb covered without sesamoid (T2); 10.5y-sesamoid just appearing (T3); 11y-distal radial physis just covered (medial double joint line, R6); 11.5y-medial capping of distal radial physis (R7); 12y-bilateral capping of distal radial physis (R8) / phalangeal capping without fusion (S3); 12.5y-distal phalangeal physes start to fuse (S4); 13y-distal phalangeal physes fused (S5); 13.5y-proximal phalangeal physes start to fuse (S6); 14.5y-proximal phalangeal physes fused (S7); 15y-distal radial physis almost fused (R10).Level of Evidence: Diagnostic study, level III.


Assuntos
Determinação da Idade pelo Esqueleto/métodos , Ossos da Mão/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Valores de Referência
9.
Adv Clin Exp Med ; 29(9): 1091-1099, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32937041

RESUMO

BACKGROUND: Experimental and clinical studies evaluating the Tp-Te interval and Tp-Te/QT ratio have reported conflicting data. The overlap between normal Tp-Te/QT ratios (0.17 ±0.02-0.27 ±0.06 ms) and pathological values (0.20 ±0.03-0.30 ±0.06 ms) measured in earlier studies has raised questions about this ECG measurement technique. OBJECTIVES: To analyze normal values of the Tp-Te interval, Tp-Te dispersion Tp-Te(d) and the Tp-Te/QT ratio based on electrocardiographic (ECG) assessment across sex and age groups in a healthy Turkish population. MATERIAL AND METHODS: A total of 1,485 healthy participants (723 men) were enrolled into the study. The age of the participants ranged 17-75 years and they did not have either any cardiovascular/systemic disorders or risk factors for atherosclerosis which were detected with physical examination and laboratory tests. The Tp-Te interval, Tp-Te(d) and Tp-Te/QT ratio were determined from V1-V6 derivations. RESULTS: For the entire study, the median Tp-Te interval was 66.0 (64.0-70.0) ms, the Tp-Te(d) was 15.0 (10.0-20.0) ms, and the Tp-Te/QT ratio was 0.18 (0.17-0.19). The Pearson's correlation test demonstrated that the Tp-Te/QT ratio significantly correlated with older age (r = 0.297; p < 0.0001), left ventricular (LV) end-diastolic diameter (LVEDD; r = 0.481; p < 0.0001), body mass index (BMI; r = 0.421; p < 0.0001), body surface area (BSA; r = 0.191; p < 0.0001), LV end-diastolic volume (LVEDV; r = 0.484; p < 0.0001), LVEDV index (r = 0.450; p < 0.0001), LV mass (r = 0.548; p < 0.0001), and LV mass index (r = 0.539; p < 0.0001). CONCLUSIONS: The reference values for Tp-Te interval, Tp-Te(d) and Tp-Te/QT ratio are associated with age, BMI, BSA, LVEDV, LVEDV index, LV mass, and LV mass index. These structural elements should be considered when using these ECG parameters for assessing repolarization inhomogeneity. These findings may guide further studies assessing healthy and diseased populations.


Assuntos
Doenças Cardiovasculares , Eletrocardiografia , Adolescente , Adulto , Feminino , Sistema de Condução Cardíaco , Ventrículos do Coração , Humanos , Masculino , Valores de Referência , Adulto Jovem
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(8): 1286-1290, 2020 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-32867437

RESUMO

Objective: To study and establish the percentile reference values of waist circumference (WC) for Chinese children aged 3-7 years. Methods: A total of 26 480 children aged 3-7 years were collected as part of the National Survey on Physical Growth and Development of Children in nine cities (Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou and Kunming) in China from June to November 2015. Sex- and age-specific smoothed percentile reference values of WC were established using the Lambda Mu Sigma method. The P(75) and P(90) curves of WC for children aged 3-7 years in this study were linked with the published P(75) and P(90) cut-off points for Chinese children and adolescents aged 7-18 years. The P(50) percentile of WC in this study was compared with the corresponding percentiles of several foreign studies. Results: The P(5), P(10), P(15), P(20), P(25), P(50), P(75), P(80), P(85), P(90) and P(95) reference values of WC were obtained for boys and girls aged 3-7 years biannually, at the interval of every six months. Results showed that WC at the P(50) had significantly increased from 47.5 cm at the age of 3 to 54.2 cm at the age of 7 for boys and from 47.0 cm at the age of 3 to 52.2 cm for girls at the age of 7. The corresponding WC percentile values appeared a bit higher in boys than those in girls at the same age, with the differences from 0.4 to 3.6 cm. The differences between measured and fitted WC at each empirical percentile ranged from -0.3 to 0.5 cm for both boys and girls aged 3-7 years. The P(75) and P(90) values of WC for boys and girls aged 3-7 years in this study presented a consistent, continuous tendency on age with the published WC cut-off points (P(75) and P(90)) for Chinese children and adolescent aged 7-18. The increasing trend of WC by age in Chinese children aged 3-7 years was consistent with those of foreign studies, at the middle level for boys and lower middle level for girls. Conclusions: Through this study, we established the WC percentile values for Chinese children aged 3-7 years and achieved the continuity in age with the published WC cut-off points for Chinese children and adolescents aged 7-18. These established WC percentile values can be used as reference for clinical practice, health care and scientific research.


Assuntos
Circunferência da Cintura , Criança , Pré-Escolar , China , Cidades , Feminino , Humanos , Masculino , Valores de Referência
11.
Respir Res ; 21(1): 252, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: covidwho-802223

RESUMO

SARS-CoV-2 is causing a pandemic with currently > 29 million confirmed cases and > 900,000 deaths worldwide. The locations and mechanisms of virus entry into the human respiratory tract are incompletely characterized. We analyzed publicly available RNA microarray datasets for SARS-CoV-2 entry receptors and cofactors ACE2, TMPRSS2, BSG (CD147) and FURIN. We found that ACE2 and TMPRSS2 are upregulated in the airways of smokers. In asthmatics, ACE2 tended to be downregulated in nasal epithelium, and TMPRSS2 was upregulated in the bronchi. Furthermore, respiratory epithelia were negative for ACE-2 and TMPRSS2 protein expression while positive for BSG and furin, suggesting a possible alternative entry route for SARS-CoV-2.


Assuntos
Asma/virologia , Infecções por Coronavirus/genética , Regulação da Expressão Gênica , Pneumonia Viral/genética , Serina Endopeptidases/genética , Síndrome Respiratória Aguda Grave/virologia , Fumar/epidemiologia , Asma/fisiopatologia , Bases de Dados Factuais , Humanos , Pandemias , Receptores Virais/genética , Valores de Referência , Sistema Respiratório/metabolismo , Sistema Respiratório/virologia , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/metabolismo , Fumar/fisiopatologia , Internalização do Vírus
12.
Medicine (Baltimore) ; 99(37): e21730, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925715

RESUMO

Abdominal aorta calcification (AAC) is associated with worse clinical outcomes in dialysis patients. However, the long-term prognostic values of AAC to cardiovascular (CV) and non-CV mortality in patients starting peritoneal dialysis (PD) remain unknown. This study is aimed to the analyze the predictive power of AAC to CV and non-CV mortality in PD patients. We prospectively enrolled 123 patients undergoing PD. All patients received quantitative analysis of AAC via abdominal computer tomography at enrollment. The AAC ratio was measured by the area of the whole aorta affected by aortic calcification above the iliac bifurcation. The CV mortality and non-CV mortality during the follow-up period were investigated using the Cox proportional hazard model and time-dependent receiver operating characteristic (ROC) analysis. After median 6.8 (interquartile range, 3.6-9.2) years of follow-up, there were 18 CV mortality, 24 non-CV mortality and 42 total mortality. The age and AAC ratio were significantly higher in CV mortality group compared with others without CV mortality. In time-dependent ROC analysis, AAC had excellent predictive power of CV mortality (AUC:0.787) but not non-CV mortality (AUC:0.537). The best cutoff value of AAC ratio to predict CV mortality was 39%. In addition, AAC was not associated with non-CV mortality but remained to be a significantly predictor of CV mortality after adjusted with clinical covariates in different Cox proportional hazard models. AAC has excellent prognostic value of CV mortality but is unable to predict non-CV morality in patients undergoing PD.


Assuntos
Aorta Abdominal/patologia , Doenças da Aorta/mortalidade , Doenças Cardiovasculares/mortalidade , Diálise Peritoneal/mortalidade , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Calcificação Vascular/mortalidade , Idoso , Doenças da Aorta/complicações , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Curva ROC , Valores de Referência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Fatores de Risco , Calcificação Vascular/complicações
13.
Medicine (Baltimore) ; 99(37): e22120, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925760

RESUMO

The purpose of this study is to study sonoelastographic features of the saphenous nerve.The study included 72 saphenous nerves in 36 healthy subjects. High resolution ultrasound and Shearwave elastography were used to evaluate the saphenous nerve. Cross sectional area (CSA) and stiffness were measured.The mean CSA of the saphenous nerve was 5.7 mm. The mean shear elastic modulus of the saphenous nerve in the short axis was 29.5 kPa. The mean shear elastic modulus of the saphenous nerve in long axis was 29.9 kPa. The saphenous nerve elastic modulus also showed no correlation with CSA in neither the long axis nor short axis. Positive correlation between elasticity measurements in the long and short axes. Age, height, weight, and BMI showed no correlation with saphenous nerve elastic modulus in short or long axes.The elastic modulus of the saphenous nerve has been determined in healthy subjects and can serve as a reference for future assessment of the saphenous nerve before different procedures.


Assuntos
Técnicas de Imagem por Elasticidade , Elasticidade/fisiologia , Nervos Periféricos/diagnóstico por imagem , Nervos Periféricos/fisiologia , Coxa da Perna/inervação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Coxa da Perna/diagnóstico por imagem , Adulto Jovem
14.
J Assoc Physicians India ; 68(9): 36-42, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32798344

RESUMO

Objectives: Ideally, the upper reference limit of plasma or serum homocysteine (Hcy) is to be defined from the studies done on individuals with normal cobalamin and folate status. It is difficult to separate the truly healthy (Cobalamin/Folate Replete) individuals from the randomly selected, apparently healthy individuals who are sub-clinically deficient of cobalamin/folate. The present study was aimed at defining the reference values for the serum homocysteine from individuals with normalized cobalamin and folate status. Methods: In our study, 215 patients with cobalamin, folic acid deficiency were treated accordingly till complete restoration of clinical and laboratory abnormalities. The post-therapy serum Hcy values were used as reference values. Results: Post-therapy serum Hcy values 12.56 µmol/L (95th percentile), 11.4 µmol/L (85th percentile), 9.8 µmol/L (67th percentile) were seen. The hyperhomocysteinemia was more visible (17.3% gain in prevalence) in the same patient group if interpreted using the post-therapy Hcy value (11.4 µmol/L) as the cut-off. There was no difference between the genders and age groups in the pre or post-therapy Hcy values. Conclusions: The benefit of the gain in prevalence of disease or the increase in the sensitivity of the test, though small, gets magnified in common diseases and in populous countries. Selection of the individuals is as important as the method or the reagent used in the method when a particular parameter is studied. Repleting the vitamin stores in the confirmed vitamin-deficient patients is more appropriate and easily feasible, since anyway they require treatment, than doing the same on the apparently healthy people. The data thus obtained can be better used as the reference value, for a more meaningful interpretation. The reference range can in turn be used to identify the sub-clinically deficient but asymptomatic people and managed accordingly.


Assuntos
Deficiência de Ácido Fólico , Ácido Fólico/uso terapêutico , Deficiência de Vitamina B 12 , Vitamina B 12/uso terapêutico , Feminino , Deficiência de Ácido Fólico/tratamento farmacológico , Homocisteína , Humanos , Masculino , Valores de Referência , Deficiência de Vitamina B 12/tratamento farmacológico
15.
Artigo em Inglês | MEDLINE | ID: mdl-32751831

RESUMO

Few studies have assessed the accuracy of self-reported questionnaires to determine smoking habits relative to urinary biomarkers. This study investigated urinary cotinine cut-off concentrations distinguishing active, passive and non-smokers among pregnant women who participated in the Japan Environment and Children's Study, a nationwide birth cohort study. Pregnant participants with measured urinary cotinine concentrations (UCCs) and who completed self-reported questionnaires on smoking status were included (n = 89,895). The cut-off values (COVs) for active and passive smokers were calculated by fitting mixed normal distribution functions to UCCs. The sensitivity and specificity of the questionnaires were subsequently evaluated. The median (interquartile range) UCC was 0.24 (0.083-0.96) µg/g-creatinine, with the detection rate of 89%. The COV for distinguishing active smokers from passive and non-smokers was 36.8 µg/g-creatinine. When this COV was considered to represent the true condition, the questionnaire had a sensitivity of 0.523, a specificity of 0.998, a positive predictive value (PPV) of 0.967 and a negative predictive value (NPV) of 0.957. The COV for distinguishing passive smokers from non-smokers was 0.31 µg/g-creatinine, with the questionnaire having a sensitivity of 0.222, a specificity of 0.977, a PPV of 0.868 and an NPV of 0.644. As many as 78% of passive smokers might be misclassified as non-smokers.


Assuntos
Cotinina/urina , Autorrelato , Fumar/epidemiologia , Fumar/urina , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Gravidez , Valores de Referência , Reprodutibilidade dos Testes
16.
Acta Derm Venereol ; 100(15): adv00249, 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32812055

RESUMO

Only recently histopathological studies of patients with dermatosis and concomitant SARS-Cov-2 viral infection were published. Seven months into the COVID-19 pandemic, more skin biopsies of COVID-19 positive patients are taking place. We examined the histological features of 30 skin biopsies from two groups of patients: Ten specimens of patients tested positive for COVID-19 with an active systemic infection and associated dermatosis. Twenty specimens were from patients not considered COVID-positive (due to PCR swab negativity or not tested at all) with cutaneous lesions either showing viral infection symptoms (fever, cough, ageusia and severe immunocompromised condition due to HIV infection and malignancies), or presented a high risk of being infected (such as cohabitation with COVID-19 positive parents and siblings with simultaneous chilblains). This study analyses the histological and immunohistochemical (SARS-CoV-2 2019-nCoV nucleocapsid antibody) characteristics of the two groups and identifies 4 histopathological patterns. The histopathological features of the two groups present similar features that may help to identify an ongoing COVID-19 infection even in asymptomatic carriers with dermatosis.


Assuntos
Doenças Assintomáticas/epidemiologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Dermatopatias/patologia , Biópsia por Agulha , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Pandemias , Reação em Cadeia da Polimerase/métodos , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Dermatopatias/epidemiologia , Manejo de Espécimes
17.
Medicine (Baltimore) ; 99(31): e21486, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756177

RESUMO

The diameter of femoral vessels was angiographically explored in pediatric patients with congenital heart disease (CHD) and compared with anthropometric and demographic indexes.A total of 153 pediatric patients younger than 3 years old were recruited. The sex, age, weight, and height of patients were recorded daily, and the body surface area (BSA) was calculated with the Mosteller formula.The values of mean left-right diameters were 3.13 (0.32) mm for the femoral artery (FA) and 5.14 (0.68) mm for the femoral vein (FV). The FA diameter (FA-Dm) and FV diameter (FV-Dm) were clearly related (R = 0.84, P < .001), and the FA-Dm/FV-Dm ratio ranged from 0.61 to 0.622. The diameters of femoral vessels were significantly correlated with age, height, weight and BSA (R = 0.63 to 0.73, P < .001). The FA-Dm and FV-Dm were most closely associated with the height of patients (FA-Dm: R = 0.73, P < .001; FV-Dm: R = 0.69, P < .001).The FV-Dm and FA-Dm were consistent with the weight, height, age and BSA in the surveyed pediatric patients. The FA-Dm and FV-Dm were closely associated with the height of pediatric patients. Furthermore, the FA-Dm/FV-Dm ratio was stable in these patients. Such estimations could help clinicians select the appropriate diameter of cannulation needles and catheters for interventional therapy pediatric patients with CHD.


Assuntos
Angiografia/estatística & dados numéricos , Artéria Femoral/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Angiografia/métodos , Antropometria , Superfície Corporal , Feminino , Cardiopatias Congênitas/patologia , Humanos , Lactente , Masculino , Valores de Referência
18.
Artigo em Chinês | MEDLINE | ID: mdl-32842208

RESUMO

Objective:Analysis of normal reference value of smooth pursuit test for normal young people. Method:Thirty normal young volunteers were tested by Synapsys videonystagmography. The maximum horizontal tracking angle was 30 °, the vertical maximum tracking angle was 20°, and the frequency was 0.30 Hz, 0.45 Hz and 0.60 Hz, respectively, and the gain under different conditions is used as the observation index. Result:When the frequency is 0.3 Hz, 0.45 Hz, 0.60 Hz, the left and right horizontal gain is 0.92±0.07/0.93±0.07, 0.87±0.08/0.88±0.11, 0.79±0.11/0.78±0.13, respectively, and the asymmetry of left/right gain is 0.021±0.017, 0.031±0.026, 0.037±0.040; the up and down vertical gain is 0.82±0.16/0.80±0.16, 0.78±0.17/0.72±0.15, 0.68±0.20/0.61±0.15, and the asymmetry of the upper/lower gain is 0.046±0.045, 0.069±0.058, 0.109±0.076. Comparing and analyzing the paired left and right gain values of the three frequencies by paired t test, the differences were not statistically significant (P>0.05). Paired t -test of gain value for different frequency of up and down stationary tracking, the difference was not statistically significant at 0.30 Hz(P>0.05), but the gain at 0.45 Hz and 0.60 Hz has significant difference(P<0.05). Comparing the gains of different frequencies in the same direction, the differences in analysis of variance were statistically significant(P<0.05). Conclusion:The gain value of smooth pursuit test for normal young people can be affected by tracking frequency and direction. At the same frequency, the left/right tracking of 3 frequencies and the up/down tracking gain values of 0.30 Hz are symmetrical, but at 0.45 Hz and 0.6 Hz, the up tracking gain is greater than the down tracking gain, and the gain value in the same direction gradually decreases with the increase of frequency, is the clinical smooth pursuit test is mainly based on 0.30 Hz.


Assuntos
Nível de Saúde , Acompanhamento Ocular Uniforme , Adolescente , Humanos , Valores de Referência
19.
Arch Endocrinol Metab ; 64(4): 462-478, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32813765

RESUMO

Hypovitaminosis D is a common condition with a negative impact on health. This statement, prepared by experts from the Brazilian Society of Endocrinology and Metabolism and the Brazilian Society of Clinical Pathology/Laboratory Medicine, includes methodological aspects and limitations of the measurement of 25-hydroxyvitamin D [25(OH)D] for identification of vitamin D status, and identifies individuals at increased risk for deficiency of this vitamin in whom 25(OH)D measurement is recommended. For the general population, 25(OH)D levels between 20 and 60 ng/mL are considered normal, while individuals with levels below 20 ng/mL are considered to be vitamin D deficient. This statement identifies potential benefits of maintaining 25(OH)D levels > 30 ng/mL in specific conditions, including patients aged > 65 years or pregnant, those with recurrent falls, fragility fractures, osteoporosis, secondary hyperparathyroidism, chronic kidney disease, or cancer, and individuals using drugs with the potential to affect the vitamin D metabolism. This statement also calls attention to the risk of vitamin D intoxication, a life-threatening condition that occurs at 25(OH)D levels above 100 ng/mL.


Assuntos
Patologia Clínica , Idoso , Brasil , Humanos , Valores de Referência , Vitamina D/análogos & derivados , Deficiência de Vitamina D
20.
PLoS One ; 15(8): e0238146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841295

RESUMO

We have previously developed a new theory for pressure dependent outflow from the human eye, and tested the model using experimental data at intraocular pressures above normal eye pressures. In this paper, we use our model to analyze a hypotensive pressure-time dataset obtained following application of a Honan balloon. Here we show that the hypotensive pressure-time data can be successfully analyzed using our proposed pressure dependent outflow model. When the most uncertain initial data point is removed from the dataset, then parameter estimates are close to our previous parameter estimates, but clearly parameter estimates are very sensitive to assumptions. We further show that (i) for a measured intraocular pressure-time curve, the estimated model parameter for whole eye surface hydraulic conductivity is primarily a function of the ocular rigidity, and (ii) the estimated model parameter that controls the rate of decrease of outflow with increasing pressure is primarily a function of the convexity of the monotonic pressure-time curve. Reducing parameter uncertainty could be accomplished using new technologies to obtain higher quality datasets, and by gathering additional data to better define model parameter ranges for the normal eye. With additional research, we expect the pressure dependent outflow analysis described herein may find applications in the differential diagnosis, prognosis and monitoring of the glaucomatous eye.


Assuntos
Pressão Intraocular/fisiologia , Modelos Biológicos , Fenômenos Fisiológicos Oculares , Bases de Dados Factuais , Olho/fisiopatologia , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Glaucoma/cirurgia , Humanos , Hidrodinâmica , Valores de Referência , Análise de Regressão , Fatores de Tempo , Tonometria Ocular
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